A Veteran Psychiatrist/Parent/Writer Observes the American Culture

Month: July 2017

A few posts ago I wrote about the emergence at Methodist Hospital in Houston TX of the truly antibiotic treatment-resistant Klebsiella bacterial strain. The infectious disease and internal medicine clinician researchers had been following the presence and prevalence in patients in the ER and hospital wards since 2011 through 2015. They had recently published their results in the prestigious journal Nature.

Methodist Hospital had been tracking this dangerous bug since it was noticed in patients in that hospital in 2011 or slightly before. The Methodist Hospital clinical researchers had tracked large numbers of patients both at risk and not at risk for harboring “bad” germs such as the better known MRSA [methcillin resistant Staph Aureus bug] as all hospitals have done for over a decade or more as standard procedure upon any admission to a hospital. They were taken aback and I dare say, medically frightened by their findings that larger than expected numbers of patients had this resistant Klebsiella.

Well, now it turns out that an equally antibiotic-resistant bug, a variant of our old Gram-negative E. Coli bug has turned up in Alabama centers in an alarming incidence that cannot be ignored either. This I fear really fear is the start of what all of us in public health, medical epidemiology, infectious disease and internal medicine have anticipated for years, the start of the antibiotic resistant age with multiple bacteria being antibiotic resistant.

For several years, the strategy in treating moderately resistant bacteria has been to employ typically dual or triple antibiotics to treat infections and this has until recently been quite successful. But the thinkers and ponderers in medicine, even in psychiatry such as those who practice in large hospitals and see patients in growing numbers with medical conditions that predispose to resistant ‘bugs,’ such as modern immunocompromised patients engendered by our novel non-chemotherapeutic anti-cancer drug regimens that do not utilize ‘cell poisons’ as in the beginning days of oncology and HIV patients who are immunocompromised out of hand because of the way the HIV virus operates and its routine effects on suppressing the immune systems of the body. I myself am partially immunocompromised by the treatment I do daily for multiple myeloma and have had a few episodes of serious body-wide infections or sepsis and face with some degree of trepidation this new issue of antibiotic resistant bacteria. But a number of other populations fall into these vulnerable categories, such as infants, children, the elderly, persons on the new drugs for rheumatoid arthritis and psoriasis. These are not small elements of our populations worldwide by any means.

So without really any or too many new wonder antibiotics on the horizon to save us all, the researchers are scramblers as fast as possible in another direction that likely is better. The development of vaccines bears promise and bacteria do not change and morph and trades parts of DNA in their annual changes such as in the various flu strains and so present hopefully, slower moving targets for vaccines. It appears we will enter into a new era of vaccine research and development since the days of the polio vaccines and childhood disease vaccines.

I also would throw down the gauntlet to the anti-vaccine movement parties in this country, for whom I have a great deal of antipathy for generating in my view truly ‘fake news and information’ about the supposed harm of vaccines and causing such alarm among the relatively less educated and even well-educated parents of the last 20 years or so to let their children go unvaccinated. Because of this, we are having more and more outbreaks among the much larger cohorts of the unvaccinated of measles, mumps, whooping cough and even diphtheria as the collective “herd Immunity” is diluted by the larger numbers of unvaccinated children at the mercy of their misinformed parents. And yes as a physician I am well aware of the tragedies caused by the RARE cases of PANDA syndrome, catastrophic CNS cases of brain damage due to encephalitis which things like measles cause in large numbers in severe cases in the unvaccinated in addition to deafness and other tragic consequences. One could hope that the anti-vaccine ill-informed and just plain dead wrong movement in this country and others would wake up when the realities of the antibiotic resistant bacteria start causing widespread deaths and the only defense against them on the horizon or on the pharmacy shelves is bacterium-specific vaccines. Then when they, their elders, and their children are threatened in very real stark life and death terms, I would hope to God that they come to their rational modern day senses.

I just read this weekend a telling article in Tech Crunch of the “homogenization” [my term] of modern fashion, gadgets, and consumerism in the modern, present world. I thought it was worth commenting which I will proceed to in my combined semi-historical personal way and lead up to some telling observations if not conclusions. The article is entitled, “Converging consumer values in China and the U.S. are creating millennials without borders.” by Hans Tung.

Consumerism and its ever present ‘sidekick’ marketing/advertising has fascinated me even from my earliest childhood. I grew up with stories of my father “painting his way across Texas” when he drove to El Paso from Huntsville to El Paso in a beat up old car in 1937 or so along with three equally poor friends to enroll at and attend Texas School of Mines as it was known then. They all had the idea that they wanted to be “engineers.” My father had gotten enamored of mining engineering by reading a pulp paper published penny dreadful adventure comic about a mining engineer that he kept a copy of and showed to me when I was about five or six. He had worked in high school as a billboard sign painter to earn money and help his family get by during the Great Depression. Billboards in those days were not printed and glued on in sections or electronically programmed LED light affairs as they are now. they were hand painted. My father was proud of his work and without biased exaggeration, he was very good at it. He painted billboards for just about every business in the Huntsville, New Waverly, Conroe Texas area. Once he misspelled a word and initially did not realize it and his buddies teased him mercilessly about it. He quietly and quickly set about to repaint the word hoping his customer had not noticed it but he had. The purchaser of his services thought it was hilarious and were gratified as locals told him of the mistake and it had the unique small town effect of bringing in more customers who laughingly told the proprietor of the said business of the mistake and of course bought more goods. The proprietor almost stopped my father from correcting it. So I had an early family based to local, small town advertising. By the time our family bought a television set in the 1950’s were avalanched by the big time national Madison Avenue advertising for cigarettes [back when it was legal and routine for tobacco products to be so advertised on tv, for the young reader who may not know that actually occurred once upon a time]. Detergents, washers, car tires, gasoline and motor oil brands, and my favorite Falstaff beer pitched by the famous Dizzy Dean on Saturday afternoon baseball was my favorite since Dizzy Dean almost always comically ad-libbed some hilarious backwoods homily or addition to the advertising script. His most famous that got him in temporary hot water was “But we ain’t got no gallons.”

Then a little later I happened to run across Vance Packard’s books on advertising, its power, and sort of subliminal evil influences. That caught my eye and reading mind. I mulled those concepts over endlessly. It helped me among really many,, many other concepts that economics were a very powerful influence throughout history and especially modern life.

Decades ago I somehow realized, likely through my travels with my family growing up all over the world, that elements of American culture were permeating [sometimes I felt it was a process almost akin to the inadvertent introduction/invasion of kudzu into the South] the rest of the world starting with the more affluent countries, McDonalds, Coke and Pepsi led the way. As the years rolled on and I became inducted into the world of medicine, I began to realize we were infecting the world with harmful American products. The American diet exemplified by Mickey D’s, soft sugary drinks, candies and more. And tobacco was the worst though I think it sprang up into parts of the world autonomous in regions where tobacco was also native and grown such as Turkey etc. But in recent decades as tobacco has become more and more unwelcome in the US, the companies are migrating in an organized and hurried manner to the Far East expanding into markets with far more customers in India, China, and the Far East. And very little regulations like we have had in the US since the initial warnings of packs of cigarettes decades ago. And the rates of breathing and lung disorders, and especially LUNG CANCER have increased in those countries like a reverse ski slope in predictably horrendously rapid rates.

The other side of the coin of American invasion, leaving out American music from rock and roll to jazz, the most American and more popular of American genres [sorry, I have not forgotten such other genres such as American Bluegrass and four or five person American Christian Gospel “Quartet” music which even as a Jew I do love, but those genres are not as popular overseas], is the dreadful American Diet.. And I must echo Oprah’s correct indictment of fat laden American steak and beef as bad or at least not good for us. fatty french fries and all the rest of it, even my wife’s Cherokee fry bread which is good if an acquired taste but full of grease and fat and not good for anyone but a traditional food nonetheless. So America’s obesity epidemic has grown overseas and the evidence of it is there for all to see when we view television scenes of other countries overseas where America’s “foodie” exports have taken hold in a big way. This is not to say the American diet is not the only culprit. The German diet from personal experience is full of fattening favorites, large amounts of beer per capita, and all those fatty meaty wursts of all flavors that I cannot keep straight and other fatty but oh so tasty goodies. And even my other main cultural heritage of Latino food has its unwise but centuries old emphasis on fatty beans, greasy carbohydrates foods that I restrict myself painfully to on a once a month basis or so…

Now we have a new phenomenon in this world of mega companies exporting their not so good products to the rest of the world. Worldwide advertising through television American style has invaded the rest of the world like the “fungus among-us” that can’t be stopped. It is visual, it gets you hyped up and craving-desiring whatever product is being hawked from cereals to iPods. It is a truly essential tool of business large and small and will never go away. But American television somehow apparently got a head start on local programming in other countries and set the tone and paradigms for shows in other countries. I remember once when I turned on the tv in a Latino country where we were living at the time during one of my father’s international consulting mining engineering contracts, re-opening a mine that had an explosion and closed, or sinking a deep shaft through dangerous formations and saw American like programs in Spanish, complete with Let’s Make A Deal like shows, breaks for the usual advertising commercials, all modelled after “Amerikanski” tv as my father used to call it. And the soap operas were just as bad as American ones with every other minute bouts of scripted hysterical crises in all the relationships of actors. I was aghast and fascinated.

In the last two decades, the American invasion has increased. Everybody races their Honda two-door Civics modified to dangerous levels in streets or parking garages in Japan like American teens did with their souped up pre-dragster jalopies in the 1950’s. Clothes are American like. We had the Japanese invasion of little transistor radios briefly in the 1960’s but then American boomboxes [though made in Japan] took over and held sway especially when the hippest of all American teens, the black teens, and gangstas came to the cultural foreground. What capped it off for me has been the recent appearance of Apple’s advertisement for a pair of teens obviously in love and the male is taking adoring pictures of his girlfriend in breathtaking big city settings with the coming iPhone which is supposedly now even better for portraits. And then you realize that it is some Chinese big city and the two Millenials, the young couple are indeed Chinese. It is a good commercial and romantic on a soft, pleasant plane that is nice to watch.

And there we have it. I think it is a culmination of all this American cultural spread/plague/internationally bourne cross-pollination homogenizing many cultures. These cultures were incredibly insular and very very proudly different just decades ago. And now look at them; at times you have to look closely to see their unique differences. No wonder some countries, even with their science and modernization phobias are trying to shut out the Internet. Once you enter into the world of the Internet, you change.

In the 1970’s and 1980’s the dreadful phenomenon of newborn babies withdrawing from cocaine began to emerge on an increasing basis. This was fairly rapidly recognized in areas in which heroin addiction in pregnant mothers and the withdrawal of their newborns was already well known. As the blight of cocaine spread across the country as the cartels and then somewhat later the national and regional gangs moved violently into the cocaine distribution and territorial control of the cocaine world, this became more widespread outside the proverbial ‘big city,’ largest urban areas where it had seemed until that epoch of time that those cities were the centers of drug abuse in general, which was of course partially a myth. that myth, pejorative as it was, came to be diluted and less true as the meth epidemic hit with the recessions of the late 1990’s and the Great Housing Bubble and Financial Meltdown Recession starting in 2008 or so, thanks ironically to the richest brokerage brethren in New York City.We learned to detox newborns and treat them and their mothers in the cocaine era as we had done starting in the 1960’s in the heroin era. We began to learn though, that the effects of children exposed in utero and born into withdrawal, manifested developmental problems in their early and later childhood years. It became more obvious to the child developmental researchers in all those affiliated disciplines that detoxing the baby was only the start of the developmental treatment needs that these children would come to need. Issues of lower intelligence in certain areas, developmental delays in general in everything from learning to read and grasp the fundamental concepts presented in preschools such as shapes, colors, and even their art productions were hindered, delayed and markedly different from developmental norms. These children began to manifest aggression, hyperactivity and higher levels of aggression, inability to exhibit ordinary levels of self-inhibition, delay of rewards, ordinary sharing with others and many other social behaviors and skills that we often take for granted. In my mind these children represented a modern partial equivalent and new cohort of severe ADHD children much like the post Economo’s encephalitis that occurred in 1919 during the Spanish/Russian influenza pandemic that left many thousands of children ‘brain damaged,’ and hyperactive, and stimulated the earliest ‘child guidance clinics,’ in this country such as the Judge Baker Clinic in Boston. [This almost more than any other ‘event’ gave one of the biggest pushes to starting the discipline of child psychiatry].

Now we are on the precipice of learning through basic brain research about the long lasting and actual physical changes in children’s brains from natal exposure to drugs such as heroin and cocaine. Brain research is showing daunting, frightening and even chilling findings that children’s are functionally and developmental physically changed.

The article points to the coming era of research on childhood post addiction issues. One of those areas we already know a great deal about. There is, for instance, a growing body of social research literature concerning “Adverse Childhood Experiences,” or ACEs. This is a recent label-shorthand term used to refer to and encompass the childhoods of children, say with parents or parent, with continuing addictions and all the behaviors and child care deficits that accompany this debilitating social=medical-legal lifestyle and its effect on the young child.

One issue is that of defective attachment. Rene Spitzer the famous developmental pediatrician in Paris and others after him such as the Anna Freud group in London, the child psychoanalytic groups in New York and Boston in the decades after WWII, all demonstrated the importance of attachment between mother and caretaker in the earliest days and months of life through even the teen years. Spitzer showed the appalling effects of lack of attachment in babies in Paris orphanorges. Babies were not held by the nuns in the largely Catholic sponsored orphanages but a few times a day, when they had to be fed on strict schedules or when they had to be changed. Other than those times they were not talked to, held, sung to or anythiing. Within even the first year of life, they would develop ruminative syndrome behaviors of eructating, or vomiting up, their feedings into their mouths and chewing and mouthing them over and over simply to furnish themselves more oral stimulation to make up for the lack of physical touch and holding. They did this so much that their appetite mechanisms and social needs/drive/wishes for feeding diminished markedly. They became “anorexic,:, lost weight progressively and often died of self-starvation. Spitzer studied this by observation and head scratching developmental thinking in the immediate post-WWII years when there were so many orphaned infants and children, and also sadly due to the hardships of life in the post-war years when food and even milk was so scarce, the plentitude of abandoned infants and children by parents who could not care for them. I recall only part of a cruel angry common comment quoted in the post-WWII press that said something to the effect that it was a daily occurrence for infants to be abandoned on the steps of Catholic churches in Europe in those years.

In any case, Spitzer somehow hit upon the notion that the babies were not receiving enough holding and tactile stimulation. He noticed that infants who had begun to develop the anorectic behaviors also demonstrated a turning away from the facings and verbal ministration of the good nuns who fed and held them at their allotted times. This was, in my opinion, one of those moments of true genius in which someone like Spitzer had an epiphany before there was enough evidence in sight to easily suggest and point the way to the new idea. He began to hold certain infants both before and after they had developed the syndrome of rumination and anorexia. And he would hold them for longer and daily periods of time. He recruited more and more volunteers to do the same. And lo and behold the infants who received more holding did better, started responding interactively with their wet nurses, smile and coo and such, and eat and gain weight as well, or “thrive,” as the pediatric practitioners call this process.

The study of attachment began then.

We have seen another version of lack of attachment in an old group of perhaps millions of children more recently perhaps beginning in the 1990’s. Many many thousands of orphaned children from the broken Soviet Union came to be abandoned for reasons that are not clear to me during the years after the Soviet system crumbled. Probably it was the result of basic systems of agriculture, education, healthcare, employment for parents and national poverty making it hard for parents to adequately care for their children and they were abandoned by the hundreds of thousands. Many came to be warehoused, and I use even that horrible term apologetically, as what happened to those children was nothing short of barbaric [sorry Putin, but it’s true].

Orphanages were placed in all kinds of abandoned buildings such as old research labs, abandoned schools, university buildings, armed forces barracks, factories. Conditions were horrible. Stories began to emerge of numbers such as six thousand or more children being housed in concentration camp like conditions with perhaps staff to children ratios of 1 to a few hundred were commonly reported in the Western press. Many adoption agencies, often church sponsored and experienced organizations, geared up to try to help. The adoption of children from Siberia, the Ukraine, Russia itself, Romania and other former Soviet satellite states increased to large numbers in a short period of time. As time went on, the adoption procedures, requirements, and fees skyrocketed and lengthened. The costs averaged $20,000 to #40,000 from families I had contact with who adopted such children. The stories brought by adoption workers and parents who visited these child warehouses for required get-acquainted visits were at the least unnerving and at the worst unbelievable.

Within two years or so, child mental health professionals of all disciplines started seeing these children en masse. The children presented a myriad of behavioral, educational, social and psychological/psychiatric problems. Many were beyond diagnosis in a sense since they displayed so many possible diagnosable conditions that many of us did not know where to start first or what to emphasize, for instance even in the simple routine task of affixing a primary diagnosis on insurance claims forms. Many of them redefined the diagnosis of “reactive attachment disorder,” in form and numbers most of us had never seen before. In many of them who were adopted as older children, such as middle school, pre-teens, did not do well even with years of therapy, multiple stints of sophisticated residential long-term treatment. Those youth often left home illicitly, running away unpredictably and literally disappearing. Some resurfaced periodically or briefly and came back to their families but since they had not bonded to them, there was not strong emotional tie and they would become restless in family life and leave after brief “touching base” kinds of stays as I called them. A number of them became involved heavily in crime before they left such as drug dealing, petty or major theft. I remember one child who by age 12 was already regularly stealing and selling his stolen cars. Others would end up dead, killed in crime-related activities in other states and the families would get the sad news after those kids/adults were identified. Some were lost and no word was ever received of their fates.

Attachment deficits in the children of addicts are well described in the article referenced above. The parents cannot bond reliably as they are drinking and/or drugging compulsively, meaning in binges or nonstop and are not able to give anything in the way of a healthy, caring, “I’ll Be There For You,” as the song goes. No protection, no assurance that the child’s needs from food to clothing, to heat and electricity in the home, to school supplies, to protection from sexual predators. Consequently, most simply put these children grown wisely, unfortunately, trusting no one. They seem to have the same vulnerabilities as their addict parents, the ability to experience ordinary pleasure is largely absent. This plays a huge part in why people who are or become addicts cannot get enough of their pleasure-giving drugs. The reward centers of the addicts’ brains are changed, diminished in function and size. Ordinary pleasures such as doing well, excelling, getting praise, attaining a self-enhancing achievement, do nothing for them. These children also have a prior ‘strike against them,’ in that they have we know from research, the genetic, brain-based vulnerability to drug use and addiction. I have always thought this explained why many would use drugs briefly, and become ‘instant addicts,’ since their genetic history in their parents and extended families showed addicts everywhere in the family tree. Other folks could try some drugs [with perhaps the ominous exception of meth] briefly and not become addicts and relate in an interview, “eh, it didn’t do anything for me…”

I have held the quiet opinion-fear for over 20 years, arising out of this understanding of severe attachment disorders, that we have generated a number of national and regional cohorts of similarly disturbed children in different places. The areas of the world where we have massive economic disruptions, years of famiines, refugee problems in numbers never seen in the world before, portend to me possible populations of these very impaired children who are orphaned, left to survive on their own in conditions that are in no way supportive of adeuate child development. There are perhaps just as many areas of the world who are really coping well with this sort of ciris. In South Africa which reportedly has the world’s highest rate of parental death due to the HIV long standing epidemic there, has mobilized what look to be very good child villages adequately staffed, that offer good care to infants, toddlers, children and teens all over the country. Other countries appear to be copying this kind of effort some with increasing from western and religious based groups who see and are nobly responding tot his worldwide recent need.

But I worry that in other areas, children will have spent 20 years in war torn areas such as Lebannon until recently, functioning as “child soldiers,” as has happened in civil war ravished areas of Africa still. These children have experienced continuous war as the entire normality of their lives. I fear and foresees a generation of new mercenaries who know nothing else, young assassins and killers who have no sense of right or wrong and will be social problems in their countries for decades to come.

So that is the impor of early childhood health bonding and attachment. Perhaps the United States’ policy toward refugees should be the opposite of what is being proposed and implemented nowadays. We should take in as many refugee orphans and families as we can. We should place them in friendly communities and work to establish government sponsored as well as much as possible, local and culturally based help efforts based on the refugees’ religions and social organizations to help them learn our language, work, educate and support the healthy development of their children. They and we will be the better for it.